Site Navigation

Site Mobile Navigation

Progress on Medical Errors

The Department of Veterans Affairs recently reported that veterans' hospitals around the country committed about 3,000 medical errors leading to about 700 deaths between June 1997 and December 1998. These frightening statistics reflect what can go wrong in the veterans' health system. But they also reflect what is being done right.

Veterans' hospitals are not the only ones plagued by mistakes. The Institute of Medicine reported last month that medical mistakes kill more hospital patients than car accidents, AIDS or breast cancer. The report goaded politicians to promise corrective action, and last week eight executives of major companies disclosed the formation of an organization -- the Leapfrog Group -- designed in part to steer employees to hospitals that make the fewest mistakes.

The veterans' hospitals had already begun putting error-catching systems in place before the institute's report was released. When Dr. Kenneth Kizer took over as under secretary of veterans affairs in 1994, he found an unorganized health system lacking modern quality control or standards. The system had a reputation for bloated costs and sometimes substandard care.

Dr. Kizer brought hospitals, outpatient clinics and nursing homes together into integrated networks. He paid the networks a fixed amount of money for each veteran the network treated independent of the diagnosis, giving them a powerful incentive to spend money wisely. The doctors were paid salaries, eliminating any economic reason to under-treat or over-treat patients. Dr. Kizer closed hospitals and eliminated administrators.

''The Veterans Health Administration has made a more serious commitment to improving health safety than any other large system in the country,'' said Dr. Donald Berwick of the Institute for Healthcare Improvement, a nonprofit research center in Boston.

Beyond structural reforms, Dr. Kizer initiated a policy that requires employees of the veterans' health system to report medical errors. This policy produced the data on thousands of mistakes and hundreds of deaths over 19 months. There is no evidence that the veterans' hospitals are treating patients less safely than other institutions are, Dr. Berwick said. He argues that private hospitals would look just as bad if they reported medical errors as accurately.

The first step in overcoming errors is to report them accurately. The data from the veterans' hospitals, as grim as they are, reflect the fact that the system is moving in the right direction.